Lewis B. Woolner

Primary malignant lymphoma of the thyroid: Review of forty-six cases☆

Abstract Forty-six cases of primary malignant lymphoma of the thyroid gland diagnosed and treated at the Mayo Clinic through 1964 have been classified into two groups based on the presence or absence of extension beyond the thyroid capsule. In the twenty cases marked by invasive spread or by involvement of local lymph nodes, the treatment was surgical resection (incomplete in eleven) followed by irradiation. Four of these patients survive (three probably cured) and sixteen are dead, of whom fifteen are believed to have died of lymphoma. Ten patients underwent biopsy of invasive inoperable malignant lymphoma and were treated by irradiation. Of these, six are dead of lymphoma and four are living and well twelve to forty-six months after therapy. Sixteen patients whose malignant lymphoma was confined within the capsule of the thyroid were treated by surgical resection (usually complete) with subsequent irradiation in all but one case. Of these, generalized fatal malignant lymphoma is known to have developed in only one. In five cases of Hashimotos thyroiditis, lymphoid variant, the therapy was subtotal resection without subsequent irradiation. Over a long period of observation, malignant lymphoma or recurrence has not developed in any patient. The presence or absence of locally invasive tendencies appears to be of major importance in the prognosis of primary thyroidal lymphoma.

Acinic cell carcinoma of the major salivary glands

Abstract A study was made of fifty patients having acinic cell carcinoma, including forty-seven tumors of the parotid gland and three sub-maxillary tumors, treated at the Mayo Clinic from 1918 through 1961. Follow-up study in forty-six cases ranged from one to forty-one years after initial treatment. Evidence presented supports the concepts that these tumors originate in acini of the salivary gland and that they should be considered as malignant tumors. The results of treatment indicate that a more aggressive surgical approach at the time of initial therapy offers the best opportunity for cure. More than 100 cases of acinic cell carcinoma of the parotid gland have been reported in the literature.

Tumors of the Submaxillary Gland

Abstract Study of 128 cases of neoplasms of the submaxillary gland in which operation was performed at the Mayo Clinic from 1936 through 1955 with careful attention to classification of the lesions and comparison of findings in the literature on other salivary tumors yielded the following observations and conclusions. 1. 1. Benign mixed tumor is the most common tumor found in the submaxillary gland. Its predominance, however, is less than in the parotid gland. 2. 2. Cylindroma is the most common malignant tumor in the submaxillary gland and is relatively more common in the submaxillary gland than in the parotid gland. 3. 3. Benign tumors of the submaxillary gland are found in younger patients than are malignant tumors. 4. 4. Benign tumors tend to be smaller, more stationary in size, give less pain and show less tendency to local invasion than do malignant tumors. 5. 5. Both benign and malignant tumors, that later recur, begin at an earlier age than tumors that do not recur. 6. 6. Removal of the entire submaxillary gland with the tumor is the treatment of choice for all benign tumors and well encapsulated malignant tumors. More radical surgical procedures are preferable for locally invasive malignant tumors. 7. 7. Recurrence is rare after surgical treatment of benign tumors of the submaxillary gland. 8. 8. Following adequate surgical treatment, approximately half of the patients with malignant tumors of the submaxillary gland will live five years without evidence of recurrence. 9. 9. Recurrence may develop in patients with cylindroma more than five years postoperatively, but a ten year follow-up without recurrence should be synonomous with cure.

Parotidectomy in the treatment of chronic sialadenitis.

Abstract A series of twenty-nine cases is presented in which thirty parotidectomies were performed for recurrent chronic sialadenitis. The results during the follow-up period have been excellent, except in one case in which subtotal parotidectomy had been performed and a recurrence developed five months later. Based on the experience in this series it is recommended that when symptoms of chronic or recurrent parotitis are of sufficient severity and duration and do not respond to conservative measures, subtotal or total conservative parotidectomy should be performed. With proper technic these procedures can be performed without danger of injury to the facial nerve and with complete relief of symptoms.

The surgical aspects of thyroiditis

Abstract All cases of thyroiditis for the five year period 1957 through 1961 at the Mayo Clinic were reviewed with special reference to the surgical aspects of the disease. It is pointed out that every case of invasive fibrous thyroiditis (Riedels struma) is a surgical problem. The condition strongly resembles carcinoma on the basis of clinical findings and on gross examination at operation. The diagnosis of granulomatous thyroiditis is usually based on clinical and laboratory findings. Needle biopsy is indicated in the atypical case. In approximately 10 per cent of patients an asymptomatic lump is the only finding, and surgical removal is necessary to exclude carcinoma. In the majority of patients with Hashimotos disease, needle biopsy is advisable for definitive diagnosis. Failure to respond to medical treatment or the presence of suspicious findings on palpation provides reason for surgical resection.

Sputum Cytologic Diagnosis of Upper Respiratory Tract Cancer

Sputum cytologic testing has been applied in the screening of high-risk individuals for presymptomatic lung cancer. This same screening procedure sometimes identifies patients with upper respiratory tract cancers and thereby may permit earlier treatment. Patients enrolled in the Mayo Lung Project undergo sputum cytologic and chest roentgenographic screening at four-month intervals and are compared with matched controls who are not intensively screened. Experience to date indicates an incidence rate of approximately 1 per 1,000 per year of cancer in the upper respiratory and alimentary passages among males more than 45 years old who are heavy cigarette smokers. This compares with a rate of approximately 4 per 1,000 per year of lung cancer. Recognition of early cancer of the upper respiratory tract is an additional benefit of screening for lung cancer. Since cigarette smoking represents an etiologic agent common to both upper and lower respiratory tract cancers, tumors should be searched for in both sites in this high-risk population.

Sputum Cytologic Diagnosis of Upper Respiratory Tract Cancer Second Report

Screening for cancer is a popular issue for debate because few, if any, evaluations of the screening process have been conducted on a long-term prospective basis with use of concomitant, unscreened controls. We have found that screening of high-risk persons for presymptomatic lung cancer will identify patients with cancer in the upper and lower respiratory passages. Randomly selected patients enrolled in the Mayo Lung Project have undergone sputum cytologic and chest roentgenographic screening at four-month intervals and were compared with randomly selected matched control subjects who were not intensively screened. The search for upper airway tumors in the head and neck region was instigated by abnormal findings on sputum cytology in 12 screened patients. In the same period, 12 other screened patients with abnormal results of sputum cytology were found to have roentgenographically “occult” lung cancer. This finding emphasizes the importance of the otorhinolaryngologic examination in screening programs for airway cancer. It is also important to emphasize that sputum-negative patients may have obvious, symptomatic tumors of the upper aerodigestive tract that can be easily diagnosed by those who are skilled in examining this area. Contrary to our expectation, there is no definitive evidence that screening has reduced mortality from either upper or lower airway cancer.

Use of a Pulsed-Flow Lavage Unit for Bronchial Washing

A pulsating lavage irrigation system was employed during diagnostic bronchoscopy in patients with suspected bronchogenic carcinoma to facilitate collection of specimens for cytologic examination. No untoward effects were observed, and good quality samples of exfoliated cells were recovered. This method also might have application in the management of patients with suppurative lung disease or retained secretions and in situations in which a large volume of lavage solution is desired.